Caesarean Use Debated By Doctors Laziness, Malpractice May Increase Surgery

September 27, 1986|By Rosemary Goudreau of The Sentinel Staff

Doctors in private for-profit hospitals perform too many Caesarean sections for their own convenience, a Tampa doctor said Friday at a national meeting of Lamaze childbirth instructors.

Not so, said a Winter Park obstetrician who blames the rise in Caesarean births on the fear of malpractice suits.

Debate about Caesareans stirred an emotional response among Lamaze instructors holding their annual meeting at the Sheraton World hotel in Orlando. Many instructors said they should do more to reduce the number of C- sections in the United States. The annual number has risen about 400 percent in 15 years.

Dr. J.K. Williams, director of obstetrics at the University of South Florida College of Medicine, criticized his colleagues in private hospitals. He reported a study comparing the number of Caesareans at Tampa's downtown public hospital with the number at a private hospital across town.

From 1978 to 1984, 13 percent of pregnant women gave birth by surgery at Tampa General compared with 29 percent at Humana Women's Hospital, he said.

''There is a single factor responsible for the dramatic increase. It's not fetal distress, not a change in attitude toward breech births, not even herpes,'' Williams said.

He attributed the private hospital's higher rate to a higher number of pregnant women diagnosed with cephalopelvic disproportion, meaning that the fetuses are too big to move down the birth canal.

''They should call it WCO -- won't come out,'' Williams said. ''You might want to say they won't come out at the physician's convenience. You might want to say the physician wants to get out on the golf course.''

A spokeswoman for Humana Women's Hospital said later that doctors, not hospital officials, decide when women should have Caesareans.

''It's a purely clinical decision that has to be evaluated on a case-by- case basis,'' said spokeswoman Amy Abbott.

When asked if she could explain why Humana Women's rate is double that of Tampa General's, Abbott said the hospital has no control over decisions made by doctors.

While some doctors defend rising C-section rates by saying it results in fewer fetal deaths and injuries, Williams said little information is available to support that argument.

Dr. John Guarneri, a Winter Park obstetrician, said there are four good reasons for Caesareans: difficult labor; breech, or feet-first, position of the fetus; fetal distress; and a history of having given birth by C- section. ''We live in the real world,'' he said. ''As far as the liability situation is concerned, there's no question that if you speak to physicians privately, and some publicly, they will admit they will twist their surgical hand toward Caesarean sections.''

Williams said he recognizes the malpractice threat guides decisions for some obstetricians, but that many are too quick to perform surgery.

The two doctors also disagreed on whether women must give birth by Caesarean if their first child was born that way.Williams said many studies show that ''the vast majority'' of women can safely give birth vaginally despite having previously given birth by C-section.

Guarneri said he recommends Caesareans for women who already have had given birth that way.